For every EMS provider, regardless of their level of experience, a solid understanding of two fundamental principles is indispensable: pathophysiology and Ems Differential Diagnosis. Grasping the basics of ventilation and perfusion lays the groundwork, but the ability to apply pathophysiology to assess a patient’s condition and then formulate an ems differential diagnosis is where effective prehospital care truly begins.
It’s time to move beyond the outdated notion that EMS personnel cannot or should not diagnose. While we may not have immediate access to the extensive diagnostic tools found in a hospital setting – at least not yet – our assessment capabilities are continually expanding. With an evolving toolkit that includes advanced technologies like ultrasound and point-of-care lab tests on the horizon, coupled with our most critical asset – our clinical judgment – we are more than capable of diagnostic thinking. In fact, to select the most appropriate treatment and effectively apply protocols, we must be able to consider potential conditions and engage in ems differential diagnosis.
So, the crucial question becomes: how do we effectively teach ems differential diagnosis to aspiring and practicing EMS professionals?
To address this, I’ve developed a series of dynamic, in-class learning exercises specifically designed to enhance the teaching of ems differential diagnosis. These exercises are readily available for you to download here and can be used as a practical resource as you delve deeper into this discussion. These exercises utilize the common complaint of chest pain and discomfort as a framework to cultivate differential diagnostic thinking skills.
Exercise 1 – Foundations of Differential Diagnosis
Part 1 – Criticality and Frequency
A key challenge in ems differential diagnosis is distinguishing between common, less critical conditions and rare but life-threatening emergencies – separating the “horses” from the “zebras.” This exercise presents ten potential causes of chest pain and discomfort, challenging students to evaluate each based on two crucial factors: criticality and frequency. For instance, angina is relatively common and can be serious, while ascending aortic aneurysms are rare (affecting 6-10 per 100,000 individuals) but pose an extreme threat when they occur. This exercise, though straightforward, offers a valuable perspective for students learning ems differential diagnosis.
Part 2 – Assessment Techniques
Building upon the understanding of criticality and frequency, this section of Exercise 1 focuses on the practical application of assessment techniques for each condition within an ems differential diagnosis. Students consider when each assessment technique is most relevant in the patient evaluation process. This part adds a functional dimension to the exercise, emphasizing the practical steps involved in patient assessment to inform ems differential diagnosis.
Exercise 2 – Differential Diagnostic Practice
Exercise 2 provides students with six concise yet realistic patient scenarios specifically designed to promote differential diagnostic thinking. A seventh scenario encourages higher-level cognitive engagement by prompting students to create their own scenario, further solidifying their grasp of ems differential diagnosis.
For each scenario, students are tasked with identifying three crucial categories of information to guide their ems differential diagnosis:
- History: What pertinent information can be gathered from the patient’s history to aid in diagnosis? This includes medications, often-underestimated risk factors in EMS, past medical history, and more. A thorough patient history is foundational to effective ems differential diagnosis.
- Direct Questions: Emphasize the importance of targeted questioning, especially in medical patients where hands-on assessment may be less revealing than in trauma. Students should consider asking about key symptoms like increased dyspnea on exertion, orthopnea, syncope or near-syncope, palpitations, weight gain, and pleuritic pain. These targeted questions form a vital part of a comprehensive cardiac and respiratory system examination crucial for accurate ems differential diagnosis.
- Physical Assessment: While vital signs and lung sounds are typically considered, encourage students to broaden their physical assessment skills. This includes looking for Jugular Venous Distention (JVD), pedal or sacral edema, chest palpation, and other valuable physical assessment techniques that contribute to a robust ems differential diagnosis.
These lists are not exhaustive but serve to guide students in the essential elements of patient assessment for ems differential diagnosis.
Click here to download the Differential Diagnosis Exercises
Integrating Differential Diagnosis Exercises into EMS Education
To maximize the effectiveness of these exercises, remember these fundamental guidelines for incorporating them into your EMS education program:
- Active Facilitation is Key: Instructors must actively guide the activity to ensure students fully benefit from the ems differential diagnosis exercises. Passive implementation will diminish their impact.
- Demonstrate Value: If instructors do not actively review the exercises and emphasize their importance, students are less likely to engage seriously with the concepts of ems differential diagnosis.
I often divide students into groups for these exercises, fostering collaborative learning. Each group then designates a presenter to share their findings, promoting communication and articulation of their ems differential diagnosis process. Each exercise includes guiding questions at the bottom of the page to facilitate discussion. Here are some additional questions to enhance your facilitation of ems differential diagnosis learning:
- Why might different groups assign varying levels of criticality and frequency to the same conditions in ems differential diagnosis? Is this variation acceptable and a valuable part of the learning process?
- If different groups select different assessment techniques for the same condition, how can this be used as a teaching moment in ems differential diagnosis?
- In the first scenario of Exercise 2, a patient attributes his chest pain to exercise, while his wife suspects a myocardial infarction (MI). Can we definitively differentiate between these two in the prehospital setting? How does assessment for ems differential diagnosis influence patient refusal scenarios?
- What is a “pertinent negative” in patient assessment for ems differential diagnosis? Why is understanding and identifying pertinent negatives crucial in prehospital care?
- Ask students to reflect on whether they believe they obtained sufficient information in the scenarios to formulate a diagnosis. How close are they to making treatment decisions and providing a comprehensive hand-off report at the hospital based on their ems differential diagnosis?
These exercises are adaptable for students at all levels of EMS training. For EMT students, emphasize how body system assessments contribute to ems differential diagnosis. In advanced courses, delve deeper into the complexities of diagnostic reasoning and incorporate the additional tools available to advanced providers to refine their ems differential diagnosis skills.
I encourage you to utilize these exercises in your EMS programs. Based on my experience over several semesters, students have successfully used these tools to enhance their assessment skills, improve patient prioritization, refine their clinical thinking, and strengthen their diagnostic abilities in ems differential diagnosis. I am confident they can benefit your students as well. Please share your experiences and feedback!
